Non-Cognitive Symptoms Can Precede Dementia

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In people who will develop dementia, non-cognitive symptoms can precede cognitive decline, according to a study published in Neurology.

Symptoms such as irritability, depression, and nighttime behavioral changes can signal a potential risk for dementia even before any mental decline occurs.

The study used data from 34 Alzheimer’s disease centers in the United States, spanning from September 2005 to March 2013. It included 2,416 participants who were cognitively normal at baseline and had no positive symptoms on the Functional Activities Questionnaire (FAQ), the Geriatric Depression Scale (GDS), or the Neuropsychiatric Inventory Questionnaire (NPI-Q). Of these, 1,198 participants remained cognitively normal, and 1,218 went on to have a Clinical Dementia Rating (CDR) of >0.

Of those who developed cognitive impairment, 97.2% had very mild dementia (CDR=0.5), 2.1% had mild impairment (CDR=1), 0.7% had moderate dementia (CDR=2), and 0.1% had severe dementia (CDR=3).

The researchers compared the order of symptom development between participants who did not develop cognitive decline and those who did. Participants in both groups develop symptoms in a similar order, but those who developed cognitive decline experienced each symptom sooner than those who did not.

They found that these non-cognitive symptoms occurred in three phases: irritability, depression, and nighttime behavioral changes; anxiety, appetite changes, agitation, and apathy; and finally, elation, motor disturbances, hallucinations, delusions, and disinhibition.

These results indicate that behavioral symptoms should be monitored more closely to see if they indicate early possibilities of cognitive decline. These markers may allow researchers to develop earlier interventions to prevent as much cognitive decline as possible.

Confused woman
Non-Cognitive Symptoms Can Precede Dementia

The purpose of this study was observe the natural time course of noncognitive symptoms before the onset of symptomatic Alzheimer disease dementia.

Using the National Alzheimer's Coordinating Center Uniform Data Set from September 2005 to March 2013, data from cognitively normal individuals who were aged 50 years or older at first visit and had subsequent follow-up were analyzed. Survival analyses were used to examine the development of particular symptoms relative to each other on the Neuropsychiatric Inventory Questionnaire (NPI-Q), Functional Activities Questionnaire, and Geriatric Depression Scale, and to compare the development of individual symptoms for persons who did and did not receive a Clinical Dementia Rating (CDR) >0 (indicating abnormal cognition) during the follow-up period.

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